With piercing sadness, Anna Grace Itoju sat speechless at the entrance to the outpatient section at Tiriri health centre, her red eyes fixed on the still little girl on her lap, her chin slumped in her right palm. She looked lost in thought and in need of help.

The last time I had been here, a woman had lost her baby to malaria, and Itoju's sadness made me fear the worst.

On talking to her, I discovered that Itoju's daughter, Fiona, five, had a very bad case of malaria and she would not eat or drink anything. A clinician had prescribed intravenous quinine, but the health centre did not have any, neither did it have Coartem, the official frontline drug for malaria. Itoju was told to buy the medicine from the nearby Atirir trading centre. As she did not have the UShs 8,000 (US$4), she returned with cheaper injectable quinine.

"They sent you for IV quinine, why have you bought this one for injection?" asked a nursing assistant I had requested to assist Itoju.

"I don't have money," Itoju mumbled, looking up at the younger woman painfully.

"But it is written here clearly, 'IV quinine'," the nurse snapped, inviting an uneasy silence.

As a health centre IV, Tiriri is a mini hospital, the major facility serving Katine and neighbouring sub-counties. That the centre often runs out of effective medicines for malaria – a big killer in the country – is a distressing statement about the state of public healthcare in rural Uganda.

While medicines for most common ailments can be bought from drug shops at Atirir trading centre, located just outside the health centre, if Itoju needed obstetric care or other surgery, she would have to travel around 30km to the referral hospital in Soroti town. And this is not because Tiriri is a village clinic that can't offer better services, as I found out from Charles Elepu, the man in charge of its theatre.

"What is missing to make this theatre operational is very small compared to what is already in place," Elepu said as he guided me around the theatre, now covered in cobwebs and dust and with only one functional gadget – a pair of wind-propelled fans.

Built about seven years ago, the theatre has all the equipment it needs to be effective, and, in Elepu, it has someone who knows his stuff. It has four autoclaves, of various sizes, for sterilising equipment, an operating table, two delivery suites, oxygen cylinders and concentrators, a suction machine and ultrasound scanner.

To be functional, the cemented floor would have to be replaced with tiles or terrazzo, Elepu tells me, and the wind-fans would have to be replaced because they let dust into the theatre.

But what the theatre lacks are the two important elements it needs – water and electricity.

Water and power

Access to a constant water supply is tantalisingly close. Water from the National Water and Sewerage Corporation was extended to the health centre compound last year, but it has now been turned off over a $300 bill.

The new clinical officer in charge of the centre, Samuel Malinga, says water was not budgeted for in the current financial year, but the bill should be paid soon. He is worried about how future bills will be managed, though. And the plumbing system needs to be redone. According to official figures, Tiriri has about UShs 11m ($5,800) for operations for the whole financial year, but this money is inadequate for such a large facility.

The theatre also needs power. A generator lies idle. It needs fuel to run and there's no money for fuel. So, at night, the place is dark, except for a single kerosene lantern in each ward, a candle here, a wick lamp there. Although Tiriri is fitted with a solar system, the bulbs and tubes have since burnt out. Malinga says he is still waiting for the men from the district to come to fix the lights.

Amref plans to repair the theatre and blames any delays on lengthy consultations with the Ministry of Health. For the last two years, Amref has also been planning to install a solar-powered system to pump borehole water to the health centre. That is also still at the planning stage, with work involving Amref, the Soroti district water office and the Directorate for Water Development. Yet, even if all these things were done, the theatre would remain closed.

"The biggest challenge we have with the theatre at Tiriri is staffing," says Dr Charles Okadhi, the Soroti district health officer (DHO). "Tiriri is supposed to have two doctors: a senior medical officer and a medical officer, and the lab needs anaesthetic staff and some additional nurses."

Okadhi says last year the district advertised for doctors at Tiriri, but did not get any applications. The district hopes to re-advertise the positions in March.

But why don't doctors want to work in Tiriri? "Many doctors prefer to work in urban areas and there are many NGO projects that pay much higher salaries than the district can afford," Okadhi says.

The starting monthly net salary for a doctor in a government unit is $340, while some NGOs can pay three times more. In a bid to attract and retain doctors, the district administration resolved to pay each doctor a top-up allowance of about $100. But Okadhi says this money is not promptly paid because it comes from locally generated revenue, which is tiny compared to the district's funding needs.

No powerful lobby

Although the government has just laid a power line through Katine to the neighbouring district of Kaberamaido, there is no power going to Tiriri health centre, which is barely 6km from the line. The centre actually had power but the lines were vandalised during the Lord's Resistance Army rebel insurgency seven years ago. Some of the poles and wires survive, so repairing them would not be overly expensive.

Okadhi is not aware of any plans to extend the power to the health centre. What, I ask, would it take to get the government to extend power to this major health facility? A very powerful lobby, he says.

Every now and then an MP will tell the national press how he lobbied the authorities to take power to his constituency; so I place a phone call to Peter Omolo, the MP responsible for Katine, to see if he is doing anything. He complains about the inadequate staffing at Tiriri and the lack of drugs. These, he says, are problems the central government must address.

"It is not only Tiriri that does not have power, but several other health centres," Omolo says. "I intend to write to the Rural Electrification Agency to push for these facilities to get power." We'll wait to see if he does write, and what the outcome is.

Back at Tiriri, as I leave, I check on Anna Grace Itoju. She is seated on the lawn outside the female ward, her head still resting in her right palm. Her daughter has received two injections of quinine. The two now have to go back home, which is 6km away.

"We are going to have to walk back home, but I am still resting. I am too tired," she says.